Many Roads to Rome
Massachusetts General Hospital
2025-10-19
Traditional Approach:
The Question:
“Who will have an event in the next 10 years?”
What’s Missing:
Better Question:
“What is their lifetime burden, and when should we intervene?”
Profile:
Key Evidence:
The Concept:
Genetics provides early signal → Lower threshold for intervention
Progression:
Key Evidence:
The Concept:
Biomarkers accumulate → Intervene at transition points
Profile:
Key Evidence:
The Concept:
Alternative risk pathway → Missed by traditional models
Characteristics:
Questions:
The Concept:
Learn from success → Identify protective factors
Starting Point (Age 30-40):
This provides the baseline trajectory
Over Time (Age 40-70):
Uncertainty decreases as information accumulates
Available Now:
On the Horizon:
Challenges:
How do we reconcile population models with individualized prediction?
Can life-course prediction be practically implemented?
How do we bridge lifetime risk with current practice?
Communication:
Testing strategies:
The Core Concept:
The Opportunity:
The Path Forward:
The Question:
How do we move from 10-year risk thresholds to lifetime trajectory management?
Sarah Urbut, MD PhD
Massachusetts General Hospital
Questions for Discussion:
Heart House Roundtable | Session 2